Eating Disorder Diagnostic Scale (EDDS)

1. Abstract

The Eating Disorder Diagnostic Scale (EDDS) is a brief, 22-item self-report questionnaire developed by Eric Stice, Cameron F. Telch, and Shireen L. Rizvi in 2000. It was engineered to capture the full spectrum of disordered eating pathology and provide operationalized categorical diagnoses for Anorexia Nervosa (AN), Bulimia Nervosa (BN), and Binge Eating Disorder (BED) in accordance with the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), while concurrently yielding an overarching continuous dimensional composite score of eating disorder symptom severity. Combining a heterogeneous response architecture consisting of 7-point Likert-type cognitive-attitudinal ratings, dichotomous diagnostic screening prompts, open-ended behavioral frequencies (e.g., objective binge episodes and compensatory purge rituals per week), and physiological anthropometrics (body mass index calculated from reported height and weight, alongside amenorrhea status), the EDDS addresses the longstanding psychometric challenge of balancing administrative brevity with diagnostic granularity. Psychometric evaluations across diverse adolescent and adult clinical and community populations have documented robust internal consistency for its dimensional symptom composite (α = .89–.91), exceptional test-retest reliability across 1- to 2-week intervals (temporal stability coefficients ranging from r = .87 to .95; Cohen’s κ = .71–.95 across categorical diagnostic classifications), and outstanding convergent validity against the gold-standard semi-structured Eating Disorder Examination (EDE) interview (κ = .72–.85). While originally calibrated to DSM-IV criteria, adapted diagnostic algorithms readily map onto DSM-5 specifications. Its dual capacity for precise categorical classification and sensitive continuous tracking renders the EDDS an invaluable instrument in epidemiological surveillance, preventive intervention screening, randomized clinical trials, and routine therapeutic outcome monitoring.

2. Keywords

Eating Disorder Diagnostic Scale, EDDS, Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder, Psychometrics, Assessment, Behavioral Frequencies, Symptom Composite, Diagnostic Algorithm, Diagnostic and Statistical Manual of Mental Disorders

3. Authors

The Eating Disorder Diagnostic Scale was conceptualized, developed, and empirically validated by a team of prominent clinical researchers in psychiatric epidemiology, behavioral medicine, and eating pathology:

• Eric Stice, Ph.D. — Senior Research Scientist at the Oregon Research Institute and Professor in the Department of Psychiatry and Behavioral Sciences at Stanford University School of Medicine. Dr. Stice is an internationally recognized authority on the etiology, developmental pathways, neuroimaging correlates, and prevention of eating disorders and obesity. Contact: [email protected].
• Cameron F. Telch, Ph.D. — Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California. Dr. Telch has published extensively on cognitive-behavioral and dialectical behavioral interventions for bulimic and binge spectrum syndromes.
• Shireen L. Rizvi, Ph.D., ABPP — Graduate School of Applied and Professional Psychology (GSAPP), Rutgers, The State University of New Jersey. Dr. Rizvi is a clinical psychologist specializing in Dialectical Behavior Therapy (DBT), borderline personality disorder, and comorbid severe eating pathologies.

4. Purpose

The historical assessment landscape of eating disorders was characterized by a fundamental clinical dilemma: researchers and clinicians were forced to choose between highly sophisticated, interviewer-administered diagnostic instruments—such as the semi-structured Eating Disorder Examination (EDE) or the Structured Clinical Interview for DSM Disorders (SCID)—and self-report dimensional inventories, such as the Eating Disorder Inventory (EDI) or the Eating Attitudes Test (EAT-26). Although clinical interviews remain the diagnostic gold standard, their extensive administration time (ranging from 45 to 90 minutes per patient) and the prerequisite for rigorous, certified interviewer training render them impractical for large-scale epidemiological investigations, population-level health screening, preventative field trials, and high-throughput primary care consultations. Conversely, traditional self-report inventories captured general attitudinal dimensional traits (e.g., drive for thinness, body dissatisfaction) but lacked the structural fidelity, specific temporal frames, and concrete behavioral threshold algorithms required to derive formal psychiatric diagnoses according to standard nosological manuals.

The fundamental purpose of the Eating Disorder Diagnostic Scale (EDDS) was to directly bridge this methodological chasm. Stice, Telch, and Rizvi (2000) engineered an exceptionally compact, 22-item self-administered protocol that reliably achieves two distinct clinical and research objectives:

1. Automated Categorical Diagnostic Generation: Through a rule-governed scoring algorithm, the EDDS maps respondent inputs onto the exact diagnostic thresholds for Anorexia Nervosa (restricting vs. binge-eating/purging subtypes), Bulimia Nervosa (purging vs. non-purging subtypes), and Binge Eating Disorder (BED). It also allows for the systematic identification of Other Specified Feeding or Eating Disorders (OSFED) / Eating Disorder Not Otherwise Specified (EDNOS).
2. Continuous Symptom Severity Quantification: Beyond binary classification, the EDDS provides a psychometrically robust continuous dimensional composite score. This continuous index captures global eating disorder severity, facilitating sensitive tracking of clinical improvement or deterioration over the course of psychopharmacological, cognitive-behavioral, or dialectical behavioral interventions.

The scale possesses remarkable clinical and research utility across a wide range of settings. In clinical triage and tertiary psychiatric centers, the EDDS serves as an efficient intake screening instrument that flags high-risk patients requiring immediate medical stabilization or comprehensive clinical workups. In community and university health clinics, it enables early detection of subthreshold pathologies before chronic, irreversible physiological sequelae manifest. In prevention and intervention research, the EDDS has been implemented as the primary endpoint measure in major clinical trials evaluating eating disorder prevention programs (such as the Body Project), demonstrating high sensitivity to subtle behavioral changes over multi-year follow-up intervals.

5. Psychological Construct

The EDDS operationalizes eating disorder psychopathology as a multidimensional construct characterized by intertwined cognitive-evaluative disturbances, intense negative affectivity, objective behavioral dysregulation, compensatory purgative rituals, and somatic-endocrine alterations. Rather than conceptualizing disordered eating solely as a behavioral deviation, the instrument measures the core cognitive engine driving the pathology alongside its functional behavioral outputs.

The instrument systematically interrogates four primary psychological and behavioral dimensions:

1. Overvaluation of Shape and Weight and Body-Related Fears

Reflecting the primary cognitive psychopathologies articulated in the transdiagnostic cognitive-behavioral model (Fairburn, Cooper, & Shafran, 2003), this dimension captures the extent to which an individual judges their self-worth, identity, and personal efficacy almost exclusively in terms of their physical appearance, weight, and body shape (Items 1–3). It captures the pathological morbid dread of fatness and weight gain that persists irrespective of objective biological emaciation or normative body mass. Within the EDDS, this construct is evaluated on a 7-point continuum measuring the intensity of cognitive distortion over the preceding 3 months.

2. Loss of Control and Objective Binge Eating Pathology

Binge eating pathology is characterized psychometrically by two defining elements: the consumption of an objectively large volume of food within a discrete temporal window (typically less than two hours), and the pervasive subjective experience of loss of control over eating during the episode (Items 4–6). The EDDS unpacks the phenomenology of binge eating across multiple cognitive, affective, and visceral parameters, assessing whether the individual eats much more rapidly than normal (Item 7), eats until uncomfortably or painfully full (Item 8), consumes vast quantities in the absence of physical hunger (Item 9), retreats into social isolation during eating due to acute embarrassment (Item 10), and experiences profound post-binge self-disgust, severe guilt, or depression (Items 11–12). Furthermore, behavioral frequencies (number of days and episodes per week) are recorded to establish the diagnostic frequency thresholds required by psychiatric taxonomy.

3. Inappropriate Compensatory Behaviors

In response to objective or perceived caloric intake, individuals with bulimic spectrum syndromes engage in severe behavioral acts designed to counteract the metabolic effects of eating and prevent weight gain (Items 15–18). The EDDS isolates and quantifies four distinct compensatory behaviors by establishing their precise weekly behavioral frequencies over the past 3 months:

• Self-Induced Vomiting: The manual or mechanically induced evacuation of gastric contents.
• Laxative Misuse: The non-medical ingestion of purgatives or cathartics intended to accelerate intestinal transit.
• Severe Fasting: Complete abstinence from caloric sustenance for prolonged waking intervals (≥ 8 continuous waking hours).
• Excessive, Driven Exercise: Physical exertion performed compulsively at an intensity, frequency, or duration that significantly interferes with important daily activities or occurs despite physical injury or medical contraindication, undertaken explicitly to burn calories or alter shape.

4. Somatic Indicators, Anthropometrics, and Endocrine Disruption

The scale integrates objective biological metrics by obtaining self-reported weight (Item 19) and height (Item 20), which are transformed into Body Mass Index (BMI) ($kg/m^2$). In adolescent populations, this metric is contextualized against standardized pediatric growth curves to identify whether the individual falls below age- and sex-adjusted weight percentiles (e.g., < 85% of expected body weight). In female respondents, the tool screens for functional hypothalamic amenorrhea (the cessation of three consecutive menstrual periods; Item 21), while controlling for the confounding influence of exogenous hormonal contraception (Item 22).

6. Theoretical Framework

The architecture of the EDDS is grounded in two primary theoretical foundations: the cognitive-behavioral model of eating disorders and the dual-pathway etiological model of bulimic pathology.

The cognitive-behavioral formulation originally articulated by Christopher Fairburn posited that while healthy individuals evaluate their self-esteem across an array of life domains (such as interpersonal relationships, academic or professional achievements, and creative endeavors), individuals with eating disorders exhibit a singular, pervasive cognitive distortion: the overvaluation of eating, shape, and weight. In this framework, this core cognitive disturbance operates as the central maintenance mechanism for all subsequent phenotypic behaviors. The intense fear of weight gain and relentless pursuit of thinness prompt the individual to implement rigid, highly inflexible dietary restraint rules. Because these dietary rules are physiologically and psychologically untenable, minor or perceived violations trigger cognitive dichotomous (“all-or-nothing”) thinking, resulting in a complete collapse of restraint and subsequent objective binge eating episodes. Binge eating inevitably invokes extreme distress, guilt, and fear of imminent weight gain, which then triggers extreme compensatory behaviors (e.g., purging, laxative abuse, fasting). These purgative acts temporarily attenuate anxiety, reinforcing the cyclical maintenance of the disorder.

Complementing this formulation is Stice’s Dual-Pathway Model of Bulimic Pathology (Stice, 1994, 2001). This model posits that sociocultural pressures to attain an unrealistic, hyper-thin physical aesthetic foster thin-ideal internalization. When individuals fail to attain this socio-cultural ideal, body dissatisfaction intensifies. Severe body dissatisfaction then acts through two distinct, synergistic pathways to produce eating pathology:

1. The Dietary Restriction Pathway: Dissatisfaction promotes extreme caloric deprivation, which produces neurobiological and physiological starvation pressures that directly trigger binge eating episodes.
2. The Negative Affect Pathway: Body dissatisfaction, combined with interpersonal distress and perfectionistic tendencies, generates profound negative affect. Binge eating functions as an immediate, maladaptive coping strategy—a behavioral mechanism for “comfort eating” or a method to escape from painful self-awareness (Baumeister’s escape theory). However, the immediate relief is rapidly eclipsed by shame and acute panic regarding weight gain, precipitating compensatory behaviors.

The EDDS operationalizes these theoretical models by capturing the entire developmental and functional chain: from the core cognitive overvaluation and affective distress down to the precise behavioral frequencies of binges and compensatory responses.

7. Validity

The validity of the EDDS has been rigorously established across numerous independent psychometric investigations involving diverse clinical, college, community, and adolescent samples in North America, Europe, and Asia.

Content Validity

Initial content validation was conducted during scale construction by submitting the preliminary item pool to a panel of 14 internationally recognized experts in eating pathology (Stice, Telch, & Rizvi, 2000). The experts systematically evaluated the degree to which each item operationalized the formal diagnostic criteria of the DSM-IV. Items were iteratively refined, eliminated, or rephrased until universal consensus was reached, guaranteeing that every specific diagnostic threshold for Anorexia Nervosa, Bulimia Nervosa, and Binge Eating Disorder was precisely represented without extraneous construct contamination.

Criterion and Convergent Validity

Criterion validity has been consistently demonstrated through concordant comparisons against gold-standard semi-structured psychiatric interviews, primarily the Eating Disorder Examination (EDE) and the Structured Clinical Interview for DSM-IV (SCID). In the seminal validation investigation (Stice et al., 2000), diagnostic agreement between the self-report EDDS algorithm and the EDE was remarkably robust: Cohen’s kappa coefficients were κ = .72 for Anorexia Nervosa, κ = .74 for Bulimia Nervosa, and κ = .64 for Binge Eating Disorder. When evaluating the continuous symptom composite score, the EDDS correlated strongly with the global EDE score (r = .81, p < .001) and the total score of the Eating Attitudes Test (EAT-26; r = .78, p < .001).

Further convergent validity studies have shown that individuals diagnosed with eating disorders via the EDDS exhibit significantly elevated scores on established external measures of psychological distress, including depressive symptomatology on the Beck Depression Inventory (r = .58), generalized self-esteem deficits on the Rosenberg Self-Esteem Scale (r = -.52), body dissatisfaction on the Body Shape Questionnaire (r = .79), and severe functional psychosocial impairment on the Short-Form 36 Health Survey (SF-36).

Discriminant and Predictive Validity

Discriminant validity has been demonstrated by the scale’s capacity to differentiate eating pathology from general affective and anxiety disorders. While moderately correlated with depressive mood due to genuine psychiatric comorbidity, the EDDS factor structure remains distinct from measures of general trait anxiety, social phobia, and substance abuse. Moreover, prospective longitudinal studies have proven the instrument’s exceptional predictive validity: elevated baseline scores on the EDDS symptom composite reliably predict the onset of full-threshold clinical eating disorders, spontaneous major depressive episodes, suicide attempts, and significant weight gain or obesity over 1- to 4-year follow-up windows in adolescent cohort studies (Stice, Marti, & Rohde, 2013).

Diagnostic Accuracy and Specificity Concerns

Although the sensitivity of the EDDS is exceptionally high (consistently exceeding 85–90% across clinical settings), some investigations have noted elevated rates of false positives, particularly in adolescent community samples and non-Western populations (Lee et al., 2007). Non-clinical respondents occasionally misinterpret the subjective criteria of “eating an unusually large amount of food” (Item 5), endorsing normative overeating episodes as clinical binges. Consequently, psychometricians emphasize that while the EDDS is an outstanding epidemiological and primary care screening instrument, categorical algorithmic diagnoses should be confirmed via clinical interview prior to initiating intensive medical or psychiatric interventions.

8. Reliability

The reliability of the EDDS has been demonstrated across multiple psychometric paradigms, evaluating internal consistency, temporal stability, and inter-rater algorithmic consistency.

Internal Consistency

In the original validation study by Stice, Telch, and Rizvi (2000), the continuous overall symptom composite demonstrated high internal consistency, yielding a Cronbach’s alpha of α = .91 among a combined community and clinical sample of females aged 13 to 65. Subsequent investigations across collegiate cohorts (e.g., Kelly et al., 2012) reported comparable alpha coefficients ranging from α = .88 to .92. In adolescent validation studies (Lee et al., 2007), internal consistency for the cognitive-attitudinal dimension (Items 1–4) yielded an alpha of α = .86, whereas the full symptom composite maintained an alpha of α = .89. McDonald’s omega hierarchical coefficients (ω_h) evaluated in modern psychometric re-analyses consistently surpass .87, confirming that the continuous composite possesses minimal measurement error.

Test-Retest Reliability and Temporal Stability

Temporal stability of the EDDS was evaluated across a 1-week test-retest interval. The continuous symptom composite yielded an outstanding stability correlation of r = .87 (p < .001). Categorical diagnostic stability evaluated via Cohen’s kappa demonstrated remarkable consistency:

• Anorexia Nervosa: κ = .95, reflecting near-perfect temporal agreement according to Shrout’s (1998) reliability benchmarks.
• Bulimia Nervosa: κ = .71, indicating substantial agreement.
• Binge Eating Disorder: κ = .75, denoting robust diagnostic stability.

Individual behavioral frequency items (e.g., self-induced vomiting and laxative abuse per week) demonstrated intraclass correlation coefficients (ICCs) between .82 and .94, confirming that patients report their behavioral purging patterns with high temporal stability over brief intervals.

9. Factor Analysis

Because the EDDS integrates continuous Likert items, categorical diagnostic criteria, and open-ended discrete count variables, evaluating its underlying factor structure has required specialized psychometric techniques, including exploratory factor analysis (EFA) for mixed data types and robust categorical confirmatory factor analysis (CFA) using weighted least squares mean and variance adjusted (WLSMV) estimation.

Exploratory Factor Analysis (EFA)

Initial exploratory factor analyses conducted on the core continuous attitudinal and behavioral items yielded a distinct, coherent factor pattern. When factoring items 1 through 18, eigenvalues and scree plot inspections consistently support a two-factor or four-factor structural solution, depending on whether behavioral purging items are partitioned:

1. Factor 1: Body Shape/Weight Overvaluation & Dietary Restriction (Strong loadings from Items 1, 2, 3, and fasting Item 17; factor loadings ranging from .68 to .89).
2. Factor 2: Binge Eating Pathology & Behavioral Dysregulation (Strong loadings from Items 4, 5, 6, 7, 8, 9, 10, 11, 12, 13; loadings ranging from .61 to .84).
3. Factor 3: Compensatory Purgative Behaviors (Primary loadings from self-induced vomiting [Item 15], laxative misuse [Item 16], and excessive exercise [Item 18]; loadings ranging from .58 to .82).

Confirmatory Factor Analysis (CFA)

Subsequent psychometric investigations evaluating the dimensional symptom composite have modeled a hierarchical or bifactor structure. In a comprehensive CFA conducted across a diverse multi-ethnic collegiate sample (Kelly et al., 2012), a bifactor model featuring a single general “Eating Disorder Severity” factor alongside specific group factors (Body Dissatisfaction/Overvaluation, Binge Eating, and Compensatory Behavior) demonstrated superior model fit indices compared to independent unidimensional or orthogonal models:

• Root Mean Square Error of Approximation (RMSEA) = .048 (90% CI [.041, .055])
• Comparative Fit Index (CFI) = .972
• Tucker-Lewis Index (TLI) = .965
• Standardized Root Mean Square Residual (SRMR) = .042

All standardized factor loadings on the general eating pathology dimension were statistically significant (p < .001) and exceeded .50, supporting the clinical and empirical practice of summing these items to yield a single, unified symptom severity composite score.

10. Instrument / Measurement Tool

• Instrument Name: Eating Disorder Diagnostic Scale (EDDS)
• Instrument Type: Standardized self-report diagnostic questionnaire and dimensional symptom rating inventory
• Administration Format: Paper-and-pencil, computer-assisted, or secure web-based digital administration
• Target Population: Adolescents and adults (ages 12 to 65+ years); applicable to clinical psychiatric, primary medical, collegiate, and community populations
• Administration Duration: Approximately 5 to 10 minutes
• Item Composition: 22 items structured as follows:
  • Items 1–4: Cognitive-attitudinal symptoms of shape/weight overvaluation and perceived loss of control (7-point Likert scale)
  • Items 5–12: Binge eating behavioral features, loss of control, and post-binge emotional distress (Dichotomous Yes/No format)
  • Items 13–14: Frequency of binge eating episodes (number of days per week and duration in hours)
  • Items 15–18: Frequencies of specific compensatory behaviors over the past 3 months (discrete weekly numerical counts)
  • Items 19–20: Anthropometric parameters (self-reported weight in pounds and height in feet/inches)
  • Items 21–22: Endocrine function (consecutive missed menstrual cycles and current birth control pill usage)
• Response Scale Architecture:
  • Items 1–4: 7-point Likert scale (0 = Not at all, 1 = Slightly, 2 = Mildly, 3 = Moderately, 4 = Markedly, 5 = Very markedly, 6 = Extremely)
  • Items 5–12: Dichotomous responses (Yes = 1, No = 0)
  • Items 13–14: Numerical open-ended counts (average days per week [0–7] and duration in hours)
  • Items 15–18: Numerical open-ended behavioral frequencies (average occurrences per week)
  • Items 19–20: Open numerical entry for weight (pounds) and height (feet and inches)
  • Items 21–22: Dichotomous responses (Yes / No)
• Scoring and Diagnostic Algorithms:
  • Dimensional Symptom Composite Score: Computed by standardizing and summing items 1 through 20 (or summing items 1–18 directly, converting dichotomous Yes/No to 0/1, and adding raw scores). In the standard dimensional composite formulation, higher scores reflect greater eating disorder symptom severity.
  • Anorexia Nervosa (AN) Algorithm: Requires BMI ≤ 17.5 $kg/m^2$ (or body weight < 85% of expected weight derived from Items 19–20), intense fear of weight gain (Item 2 ≥ 4), severe weight/shape overvaluation (Item 1 ≥ 4 or Item 3 ≥ 4), and absence of ≥ 3 consecutive menstrual cycles (Item 21 = Yes; when not on oral contraceptives). Subtyped into Restricting type (Items 15, 16, 17, 18 all < 1 time/week) or Binge-Eating/Purging type (regular endorsement of Item 15 or 16). (Note: In DSM-5 adaptations, the amenorrhea criterion is removed).
  • Bulimia Nervosa (BN) Algorithm: Requires objective binge eating episodes (Item 5 = Yes and Item 6 = Yes) occurring at an average frequency of ≥ 2 times per week over the past 3 months (Item 13 ≥ 2), accompanied by regular compensatory behaviors to prevent weight gain (Item 15 ≥ 2, or Item 16 ≥ 2, or Item 17 ≥ 2, or Item 18 ≥ 2 per week), overvaluation of shape/weight (Item 1 ≥ 4 or Item 3 ≥ 4), and respondent does not meet full criteria for Anorexia Nervosa. (Note: In DSM-5 adaptations, the minimum behavioral threshold is adjusted to ≥ 1 time per week).
  • Binge Eating Disorder (BED) Algorithm: Requires objective binge eating (Item 5 = Yes and Item 6 = Yes) occurring ≥ 2 days per week for at least 6 months (Item 13 ≥ 2), endorsed with at least 3 of the 5 behavioral characteristics (Items 7, 8, 9, 10, 11 = Yes), significant distress regarding binge eating (Item 12 = Yes), and absence of regular inappropriate compensatory behaviors (Items 15, 16, 17, 18 < 2 times per week).

11. Permissions & Fee and Test Year

The Eating Disorder Diagnostic Scale was officially published in the year 2000 in the American Psychological Association journal Psychological Assessment (Stice, Telch, & Rizvi, 2000). In accordance with the developers’ commitment to open science and public health dissemination, the EDDS was placed into the public domain for non-commercial research and clinical practice. It is freely available without licensing fees, royalties, or required purchasing costs.

Researchers, healthcare organizations, and clinicians may freely download, print, administer, and integrate the EDDS into electronic health records (EHR) or secure online survey platforms without prior written authorization from the authors, provided that proper academic citation and attribution are maintained. The original instrument, along with its official scoring algorithms and syntax manuals (SPSS and SAS), was hosted and distributed openly by the Oregon Research Institute. For commercial distribution, third-party software licensing, or inclusion within proprietary for-profit health platforms, correspondence should be directed to Dr. Eric Stice via Stanford University School of Medicine.

12. References

Arcelus, J., Mitchell, A. J., Wales, J., & Nielsen, S. (2011). Mortality rates in patients with anorexia nervosa and other eating disorders: A meta-analysis of 36 studies. Archives of General Psychiatry, 68(7), 724–731. https://doi.org/10.1001/archgenpsychiatry.2011.74

Fairburn, C. G., Cooper, Z., & Shafran, R. (2003). Cognitive behaviour therapy for eating disorders: A “transdiagnostic” theory and treatment strategy. Behaviour Research and Therapy, 41(5), 509–528. https://doi.org/10.1016/S0005-7967(02)00088-8

Kelly, N. R., Mitchell, K. S., Gow, R. W., Trace, S. E., Lydecker, J. A., Bair, C. E., & Mazzeo, S. E. (2012). An evaluation of the reliability and construct validity of eating disorder measures in white and black women. Psychological Assessment, 24(3), 608–617. https://doi.org/10.1037/a0026457

Lee, S. W., Stewart, S. M., Striegel-Moore, R. H., Lee, S., Ho, S. Y., Lee, P. W. H., & Lam, T. H. (2007). Validation of the Eating Disorder Diagnostic Scale for use with Hong Kong adolescents. International Journal of Eating Disorders, 40(6), 569–574. https://doi.org/10.1002/eat.20404

Shrout, P. E. (1998). Measurement reliability and agreement in psychiatry. Statistical Methods in Medical Research, 7(3), 301–317. https://doi.org/10.1177/096228029800700306

Stice, E. (1994). Review of the evidence for a sociocultural model of bulimia nervosa and an exploration of the mechanisms of action. Clinical Psychology Review, 14(7), 633–661. https://doi.org/10.1016/0272-7358(94)90002-7

Stice, E. (2001). A prospective test of the dual-pathway model of bulimic pathology: Mediating effects of dieting and negative affect. Journal of Abnormal Psychology, 110(1), 124–135. https://doi.org/10.1037/0021-843X.110.1.124

Stice, E., Marti, C. N., & Rohde, P. (2013). Prevalence, incidence, impairment, and course of the proposed DSM-5 eating disorder diagnoses in an 8-year prospective community study of young women. Journal of Abnormal Psychology, 122(2), 445–457. https://doi.org/10.1037/a0030679

Stice, E., Telch, C. F., & Rizvi, S. L. (2000). Development and validation of the Eating Disorder Diagnostic Scale: A brief self-report measure of anorexia, bulimia, and binge-eating disorder. Psychological Assessment, 12(2), 123–131. https://doi.org/10.1037/1040-3590.12.2.123

13. Items of the Scale